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Home My WebLink AboutWPO201800055 Correspondence 2019-06-27N VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY FOR OFFICE USE ONLY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM ID Number: CONSTRUCTION ACTIVITIES (VAR10) Technical Criteria: 116P IIC ❑ REGISTRATION STATEMENT 2019 NEW ISSUANCE ❑ RE -ISSUANCE y MODIFICATION WITH ACREAGE INCREASE ❑ MODIFICATION WITH UTACREAGE INCREASE ❑ P" /� Existing Permit Coverage Number ('#applicable, VAR10####): ��3 / A�� I�/.fjlt?M 1]�� Section I. Operator/Permittee Information. A. Construction Activity Operator (Permittee). The person or entity that is applying for permit coverage and will have operational control over construction activities to ensure compliance with the general permit. A person with signatory authority for this operator must sign the certification in Section VI. (per Part III. K. of the VAR10 Permit). Construction Activity Operator Name: k (91? 14 ;it, ,i'� i _I Contact person: potty NON Address: City, State, Zip Code:.!"�.4z}'}_,�� Phone Number: _ 434-977-6400 Primary Email: f Ct°bbylPQ tbinc'rirsixo d? CC Email:t'eiC(@i?C?1Ci'6oldingS%T:oup.com B. Billing Information (leave blank if same as the Operator identified in Section I. A. above). This entity will receive Annual Permit Maintenance and Permit Modification Fee invoices (if applicable). Name: Contact Person: Address: City, State Zip Code: Phone Number: Primary Email CC Email: C. May we transmit correspondence electronically? You must choose YES and include a valid email in order to pay by credit card and to receive your permit coverage approval letter via email: YES y ;" NO ❑ Rev 04/2019 PAGE 1 1 7 CONSTRUCTION GENERAL PERMIT(VAR10) REGISTRATION STATEMENT 2019 Section IL Construction Activity Location Information. Project site information. A. Include a site map showing the location of the existing or proposed land -disturbing activities, the limits of land disturbance, construction entrances and all water bodies receiving stormwater discharges from the site. B. Construction Activity Name: W r_W 11=.A'. (L "i SIG i s `('S Address: WE oc C)1.T5 -rrtmi. De V. t}jA9_tJV City and/or County and Zip Codes Latitude and Longitude (6-digit, decimal degrees format): —. _ q_- 0S9 4 — ` S2.1 C. Construction Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): J =^ IE Section Ill. Offslte Support Activity Location Information. List all offsite support activities to be included under this permit registration. Enter additional areas on a separate page. Offsite areas not included on this registration may need to obtain coverage under a separate VPDES permit. A. Offsite Activity Name: yJ /'� Address: City and/or County and Zip Code: Latitude and Longitude (6-digit, decimal degrees format): B. Offsite Activity Entrance Location (description, street address and/or latitude/longtttude in decimal degrees): Section IV. Site Information. A. Acreage totals for all land -disturbing activities to be included under this permit coverage. Report to the nearest one -hundredth of an acre. Total land area of development (including the entire area to be disturbed as approved in the Stormwater 23 q Management Plan): YY Primary estimated area to be disturbed (portions with Erosion and Sediment Control Plan approval only): 0 r Offsite estimated area to be disturbed (if applicable): C. Property Owner Status: D. Nature of the Construction Activity Description (i.e. commercial, industrial, residential, agricultural, environmental): E. Municipal Separate Storm Sewer System (MS4) name (if discharging to a MS4): B. Estimated Project Dates (MM/DD/YYYY) Start date: 01 a Completion date- 0: /01 / FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE w Rev 0412019 PAGE 2 (7 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT2019 F. Is this construction activity part of a cc mmon plan of d eve lop mentor sale? YES xNO❑ G. 6' Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed. HUB RECEIVING WATERBODY(S) Section V. Other Information. A. A stormwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General VPDES Permit for Discharges of Stormwater from Construction Activities orlorto submitting the Registration Statement. By signing the Registration Statement, the operator is certifying that the SWPPP has been prepared. B. Has an Erosion and Sediment Control Plan been submitted to the VESCP Authority for review? YES>, NO C Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).: flit C. Has land disturbance has commenced? YESYNO ❑ D. If this project is using approved Annual Standards and Specifications (AS&S), attach the completed AS&S Entity Form. AS&S Entity Name (if different from the Operator identified in Section IL A.l: SEE THE FOLLOWING PAGE FOR SIGNATURE AND CERTIFICATION REQUIREMENTS AND INFORMATION Rev 04/2019 PAGE 3 17 CONSTRUCTION GENERAL PERMIT (VAR10} REGISTRATION STATEMENT 2019 Section Vf, Cwt1ffcatIM Apei= representing the operator as identified in Section I. A. and meeting, the requirements of 9VAC25.880-70. Part III. K must physically sign this certification. A typed signature is not acceptable. Please note that operator is defined in 9VAC25-870-10 as follows: ',Operator"means the owner or operator afany facility or acdvitysubject to the Ad and this chapter. in the context of stormwwter associated with a large arsmall construction activity, operator means any person associated with a construction praject that meets eitherAf thefok+wipy twouileda: r+)Xhe.Pc'rsaahasdMectoperottr>.aal.caa3ml overcaiatnrdion.pbns and speokao'oas, including Yw biktytoaaekeatoA¢ioadraasmShoxpians,dr+dspec/jiaauans.arfd)dre,petsonigdrday —dayapem"nal:cwatioloftham. ostivitles vttupralptY Ytrat�aerevreressarY xoemsate•acratpknnce-withasramswaEerpabulion.,p:ruention�daa,far ee site:orcil;mrswte penmitarVSW au ityparnitcandltionsfie., CheyaremuthoritedaooTrect workers ofo site tomrryoutoovitiesrequiredby the Srormwater pollution prevention plan or comply with other permit conditions). In the context of stormwater discharges from Munidpal Separate Storm Sewer Systems (MS4s), operatormeans the operator of the regulated ivS4 system. 9VAC25-BW-70. Part Ill. K. Signatory Requirements. Registmtion Statement. AURegbtratbn Statements shall be signed as follows: a. For a corporation: by a responsible corporate officer. For the purpose of this chapter, a responsible corporate ofjker means: (f) a president secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person wyto peFforas skIW/arpaky-making or decisiaa-mokkrgfunctkim far the tmpomtion; or fMi the manager Of one or more mmuf ecterft praducbm oroperaeing faiiNW provided the manager IS outhorieed to make management secu'b dMtgovern the operatiaeefthe regaiatedfraky rm*dingh vnigi the expkW orWOW# duly ofine$(rVratgor capital investment recommendations, and initiating and directing other comprehensive measures to assure long-term compliance with enWronmental laws and regulations; the manager can ensure that the necessary systems are established or actions token to gather complete and accurate information for state permit application requirements; and where authority to sign door Bents has been assigned ordeiegated to the manager in accordance with corporate procedures b. Fora portoership or sole proprietorship: by general partner or the proprietor, respectively; or c. Fora muMclpalky, state Jedem4 orotherpub/kagency: by either prindpol exac ufv6rAproer orroaking elected official. Forpanpas'S.ofthis :t hap ter,apa& ,1,paieuesvrtivplow dil'a:pridktagencyxod"decP)like 4 6 Wfew OU thne'OffiWmfdo 09&4Yorfa)a senlerewov&e:affx¢+rhat4ag farthe Overall opeaaCians.ofa:painopal:gecigatabicA lt!af:Lhe ogeary. Certification: "1 certify under penalty of law that I have read and understand this Registration Statement and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel property gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is to the best ofmykn*wledgeandbegeftmeaccurate,andcomplete tarmawarethat thereare siigIftantpenalties for submitting . false information including the possibility of fine and imprisonment for knowing violations." Printed' Name: Signature Waned m Intl: Date: Section VU-.Submittatdnctwcelem Submit this form to the Wegirwa Stornw ater Wniaigementf+rogram{VSMP} Authority. if the locailty is the'VSMP Authoerty, Please send your "Istration Slawmentsubmifttill dimctly to the locaft do NOT send this farm to DEQ. A liztof IocalVSMPAutharities is available bete: 'VBMP Authorities. it'DEQ is the VSMP Authority, please send to: Department of Environmental Quality Office of Stornauater ManagemeM Suite 1400 PO Box 1105 Richmond VA LUIS .vireiniaaev If the locality is the VSMP Authority, please send to: Rev 04/2019 PAGE 4 17